Complete Post Operative Instructions
Swelling is expected for more invasive oral surgical procedures. Surgical swelling reaches its maximum in 36-48 hours after surgery. It will gradually resolve over three to five days. To minimize surgical swelling, apply ice to affected facial area for 24 hours. Place ice bag over the face for 20 minutes on and 10 minutes off. If swelling develops three to five days after surgery, this is most likely due to infection. In this case, continue with prescribed antibiotics and call our office for instructions.
It is best to start pain medications while local anesthesia is still in effect. Take medications with plenty of water. For additional pain relief, narcotic pain medication (Vicodin, Tylenol #3) may be supplemented with Ibuprofen (200-400 mg), or Tylenol, staggered every two hours. If nausea develops, discontinue the narcotic pain medication and take only ibuprofen (Advil, two to three tablets). It is normal for discomfort to last up to five to seven days, gradually decreasing each day.
An increase in pain three to five days after surgery without swelling is most likely due to localized inflammation from inadequate oral rinses. Increase oral rinses aggressively every two to three hours. However an increase in pain with swelling is most likely a sign of developing infection. Continue your antibiotics and pain medications as prescribed and call our office for instructions.
Begin the prescribed antibiotics as soon as possible. Take with plenty of water and food. You must complete the course of antibiotics until finished. Follow the suggested dosage and frequency (at night while asleep, keep it as close as possible to your dosage time); If you develop any hives, rashes, or itching, discontinue antibiotics, take Benadryl (25-50 mg) and repeat every six hours until resolved and call your oral surgeon.
Drink plenty of fluids such as orange or tomato juice, ginger ale, water, tea, etc. Drink at least six to eight glasses of liquids daily to avoid dehydration. DO NOT USE A STRAW. This will cause bleeding by creating suction in the mouth. A soft diet is recommended for three to five days. Chew on the opposite side of the surgical site if possible. A diet high in protein and carbohydrates is best. Homemade eggnog, using fresh milk, eggs, and fresh fruit blended into it, is an excellent source of both. We also recommend soups, soft pasta, soft rice, Jello, soft boiled eggs, yogurt, soft cereals, and mashed potatoes. Avoid hard or crispy foods for five to seven days. If bowel habits are irregular, we suggest you take a mild laxative such as Milk of Magnesia.
Avoid smoking for at least 72 hours after surgery to prevent complications such as bleeding. For proper healing, avoid smoking for 10 to 14 days to prevent healing complications such as infection, dry socket, or incomplete closure of the surgical site.
Bleeding gradually diminishes in three to four hours after surgery and often stops completely in four to six hours. Occasionally, it may ooze until the next day. One hour after surgery, remove the gauze sponges that have been placed in your mouth. Replace with a clean gauze and bite or press down with pressure. Repeat every 30 to 45 minutes until bleeding stops.
If there is continued bleeding after six hours, place a folded gauze pad directly over the extraction socket. Bite down firmly and hold for 30 minutes. Sit upright and remain quiet. Repeat every 30 to 45 minutes as necessary. If bleeding continues, dip a caffeinated tea bag in cold water and place directly over the extraction site. Avoid spitting or using straws as that causes bleeding by creating suction in the mouth. If you are still unable to control the bleeding, call our office.
One ounce of carbonated water every hour for four to six hours will usually terminate nausea. Coca-cola syrup may also be taken, two tablespoons every four to six hours. Ginger ale or ginger tea also relieve nausea and vomiting. Follow this with mild tea or clear soup. If nausea persists, call our office for more information.
Do not rinse or brush on the evening of surgery. On the next day begin frequent oral rinses with warm salt water or plain tap water, every two hours, especially after meals. You don’t have to wake up in middle of the night to rinse. Continue this for 10 to 14 days. You can brush your teeth as usual, but avoid the site of surgery or be very gentle in that area. After the first 24 hours, you may be more aggressive with oral rinses. A special irrigating syringe may be used to improve cleansing, if necessary. The key benefit of rinsing is washing away plaque and food, therefore salt or regular water equally work well. Avoid use of alcohol-containing mouth washes for seven days.
Do not be alarmed by the following…
Loose sutures: Sutures can loosen after the surgery. This is expected in five to seven days but occasionally may occur in two to three days after surgery. Continue with aggressive oral rinses and medications as prescribed until you are seen during your routine post-operative visit. Also don’t be concerned if a suture comes off completely, even if you accidently swallow it. It will not cause harm. Continue with rinses and contact your oral surgeon for any additional recommendations.
Bruising: Bruising after surgery may occur and will present a purplish, bluish color, gradually changing to brown and yellowish. It gradually resolves in five to seven days as it moves down the neck and chest area.
Opening of incision site: A small opening may occur at the incision site (over extraction socket, implant site, biopsy site, grafted site, etc.) Continue with aggressive oral rinses and medications as prescribed. Continue with soft or liquid diet and treat the site very gently.
Bone graft material: If a site has been grafted, on occasion, you might notice loose small granules in the area. This is not a problem. Continue with oral rinses and soft diet.
Whitish tissue: White film over the surgical site might be either plaque or a variation of healing tissue color. Continue with aggressive oral rinses to remove plaque build up.
Bleeding: Bleeding decreases gradually over three to four hours after surgery and often stops completely in four to six hours. Apply pressure by biting down or placing finger pressure on gauze. A tea bag can also be applied over the surgical site with pressure. Occasionally, some slight bleeding may occur up to 12 hours after surgery; continue with the same instructions. If bleeding increases six to eight hours after surgery, call our office.
Drowsiness: Drowsiness is often the result of narcotic pain medications. On occasion, it may last several days, along with weakness. You might decide to change pain medication to non-narcotic, over-the-counter medications such as Advil or Tylenol.
While recovery is different for everyone, you may expect the following:
Level and duration of pain depends on the complexity of the surgery, technique, and patient’s tolerance. Most patients experience three to four days of elevated pain, commonly managed with pain medications such as Vicodin or Percocet. As pain gradually diminishes over the next two to three days, Ibuprofen (Advil) or Acetaminophen (Tylenol) can be used. After seven to ten days, most patients no longer have pain and may stop their medications.
Any swelling related to surgery will maximize in 36 to 48 hours following procedure, and gradually taper over the next five to seven days. Ice helps to reduce swelling in the first 24 hours. If extractions were done in a conservative fashion, you may experience no swelling at all.
Upon arrival home, you may have water, juices, soups, shakes, puree, and very soft food. A soft diet is recommended up to five to seven days. No hard, crispy, or spicy should be eaten during this period. The general rule is if you have to chew, it’s probably too hard. After seven days, patients may gradually return to normal food.
Get plenty of rest on day of surgery. Some patients may feel well enough the following day to walk and go out. That’s all right, but take it easy. Avoid strenuous activities for the first two to three days. Refrain from sports, lifting, or doing anything that requires exertion. After three days, if patients feel more comfortable, they can walk, go for a gentle swim, or do very low-impact exercise., such as swimming or walking. Mild activities may cause some pain but not enough to disturb the surgery site or open the sutures.
Most patients return to work, school, or some normal activities one to two days after surgery.